Justia Insurance Law Opinion Summaries

Articles Posted in US Court of Appeals for the Seventh Circuit
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Joy Global and Komatsu agreed to merge. Joy sent its investors disclosures required under the Securities Exchange Act, 15 U.S.C. 78n. Subsequent suits contended that Joy violated the Act by not disclosing some internal projections of Joy’s future growth that could have been used to negotiate a higher price, rendering the proxy statements fraudulent, and that Joy’s directors violated their state law duties by not maximizing the price for the shareholders. The suits settled for $21 million.The district court held that the $21 million loss is not covered by insurance. The policies do not require indemnification for “any amount of any judgment or settlement of any Inadequate Consideration Claim other than Defense Costs.” An “inadequate consideration claim” is that part of any Claim alleging that the price or consideration paid or proposed to be paid for the acquisition or completion of the acquisition of all or substantially all the ownership interest in or assets of an entity is inadequate.The Seventh Circuit affirmed. The suits assert the wrongful act of failing to disclose documents that could have been used to seek a higher price and are within the definition of “inadequate consideration claim.” The claims do not identify any false or deficient disclosures about anything other than the price. The only objection to this merger was that Joy should have held out for more money, and that revealing this would have induced the investors to vote “no.” View "Joy Global Inc. v. Columbia Casualty Co." on Justia Law

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Department of Labor regulations required the administrator of an employee benefit plan to give a claimant, “upon request,” copies of “all documents, records, and other information” that the administrator considered in making an adverse benefit determination. In 2018, the regulations were amended to eliminate “upon request” and require an administrator to provide such information “sufficiently in advance” of an adverse determination “to give the claimant a reasonable opportunity to respond.”Zall, a dentist for 20 years, sought long-term disability benefits in 2013 after pain and numbness forced him to stop working. His insurer, Standard denied the claim. In 2014, after considering additional medical information and consulting an orthopedic surgeon, Standard approved Zall’s claim, including retroactive payments. Less than a year later, Standard began reviewing his case to see if his condition was subject to a 24-month benefit limit applicable to any disability “caused or contributed to by … carpal tunnel or repetitive motion syndrome” or “diseases or disorders of the cervical, thoracic, or lumbosacral back and its surrounding soft tissue.” Standard ultimately terminated Zall’s benefits.Zall filed suit under the Employee Retirement Income Security Act, 29 U.S.C. 1001, arguing that the decision was arbitrary and capricious and that Standard violated ERISA’s procedural requirements by failing to afford him “a full and fair review.” The district court granted Standard summary judgment. The Seventh Circuit reversed and remanded. The plain language shows that the amended regulation applies; Standard failed to comply. View "Zall v. Standard Insurance Co." on Justia Law

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Sandstone operated large-scale swine farms in Scott County. Its owner also owned Red Oak. In 2007-2008, Westfield insured Sandstone. After 2008, Indemnity insured Sandstone. Star provided insurance to Red Oak. Sandstone was named as an additional insured under Star’s policy in 2009. In 2010, neighbors brought private nuisance claims against Sandstone in Illinois state court (“Marsh action”). Sandstone notified the three insurance companies. Each agreed to defend Sandstone, subject to a reservation of rights. Indemnity, citing a coverage exclusion for claims involving ”pollutants,” sought a declaratory judgment that it had no duty to defend. Sandstone withdrew its tender of defense to Indemnity, which dismissed its suit without prejudice. Star and Westfield split the defense of the Marsh action. An Illinois appellate court held that odor claims involving a hog facility are not “traditional environmental pollution” and are not excluded under insurance policy pollution exclusions, which foreclosed Indemnity’s earlier argument. Sandstone notified Indemnity, which filed another federal declaratory judgment action. In the Marsh action, a jury returned a verdict in favor of Sandstone. Westfield and then sought reimbursement of their defense costs.Reversing the district court, the Seventh Circuit ruled in favor of Indemnity. Its insurance is "excess" and Star had a duty to defend, so Indemnity’s “other insurance” provision relieves it of any duty to defend Sandstone. Indemnity is not estopped from asserting that defense because it promptly responded to Sandstone’s tender of defense. View "Indemnity Insurance Co. of North America v. Westfield Insurance Co." on Justia Law

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Humphrey was a Riteway driver. His trips began in Illinois, often ending in another state. In 2013 Humphrey drove a truck to Indiana. After he delivered the freight, Riteway directed him to another site in Fort Wayne. While driving to the pickup site, Humphrey’s truck collided with Wright's car. After cooperating with the police, Humphrey picked up his load and delivered it to Illinois. Wright sued Riteway in Indiana state court and obtained a default judgment. Riteway's Prime Insurance policy contained an endorsement that provides payments to an injured party even when the insurer need not defend or indemnify its client. A federal court determined that Riteway had forfeited the benefit of Prime’s policy but reserved questions about whether Wright could recover under the endorsement. The Indiana judiciary declined to allow Prime to attack the default judgment.Prime sought a declaratory judgment that the endorsement did not apply. The endorsement applies to any judgment “resulting from negligence ... subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980.” Those statutes have been repealed but the parties stipulated that 49 U.S.C. 31139(b)(1) applies and provides that all motor freight transportation from a place in one state to a place in another is covered. The district court ordered Prime to pay. The Seventh Circuit affirmed. Humphrey was engaged in interstate freight transportation under the statutory definition regardless of intent, whether a truck was carrying freight, or the “totality” of the circumstances. View "Prime Insurance Co. v. Wright" on Justia Law

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Jane held a minority stake in Du-Kane and Crush-Crete, companies owned by her husband, Paul, and other family members. The couple divorced in 2009. Jane died in 2017. Paul died months later. In 2017 Jane’s estate sued, alleging that Jane’s ownership interest was wrongfully diluted after the divorce. The complaint named only Du-Kane as the defendant, though the allegations concerned the actions of the couple's four sons as officers, directors, and shareholders. An amended complaint filed in 2018 added Crush-Crete and the Dunteman brothers as codefendants. The codefendants were insured under “claims made” liability policies issued in 2017 and 2018 by Hanover. With “claims made” insurance, the insured must notify the insurer of a “claim” in the policy period in which it is first “made.” If a claim goes unreported in the relevant policy period, the insurer owes no duty to defend or indemnify. The defendants notified Hanover and sought coverage under the 2018 policy. Hanover denied the request because the claim was first made in 2017 and had not been timely reported during that policy period.Hanover sought a declaration that it owed no defense or indemnity. The insureds counter-claimed breach of contract. The Seventh Circuit affirmed judgment for Hanover. The original complaint triggered a reportable claim during the 2017 policy period. Subsequent amendments to that complaint did not commence a new, distinct claim first made in 2018. View "Hanover Insurance Co. v. R.W. Dunteman Co." on Justia Law

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Bernacchi was a passenger in a taxicab insured by First Chicago when an uninsured driver struck the cab. In February 2021, an Illinois court concluded that Bernacchi was covered under the First Chicago policy up to $350,000. On February 11, 2021, Bernacchi sent First Chicago documentation, requesting $350,000, though she valued her entire loss at $680,000. On May 11, 2021, Bernacchi filed suit in federal court, alleging that First Chicago had still not done anything to adjust her claim.The district dismissed, reasoning that Bernacchi’s complaint failed to cite any contract language creating an obligation to adjust her claim or to do so within a certain timeframe; Bernacchi’s claim relied upon the Illinois Insurance Code, which does not provide a private right of action. The Seventh Circuit affirmed. The district court did not violate the party presentation rule. The parties squarely argued about Illinois insurance statutes and administrative regulations; 215 ILCS 5/215 ILCS 5/154.6 enumerates a list of acts that constitute improper claims practice, but neither it nor its surrounding statutes provide a private right of action. View "Bernacchi v. First Chicago Insurance Co." on Justia Law

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In 2012, a competitor sued Creation for trademark violations. Creation requested that Selective Insurance provide coverage. Selective refused. Creation’s settlement with its competitor prevented Creation from selling one of its primary lines. Creation struggled financially. Selective sought a declaration in Illinois state court that it had no duty to defend. Creation countersued and also alleged breach of the insurance policy. The Illinois court entered partial summary judgment for Creation on its duty-to-defend claim, limited to fees Creation incurred before the original trademark litigation was settled.In 2014—in the middle of the state-court litigation—Creation sued Selective in federal court for breach of contract and under the Illinois Insurance Code. In 2016, Creation voluntarily dismissed its state-court breach-of-contract claim with leave to refile. The Illinois court expressly reserved Creation’s right to maintain its federal action on its contract claim. After the 2017 state court award, the federal district court awarded Creation nearly $3 million in damages on the Insurance Code claim. After remand, Creation unsuccessfully sought to amend its complaint to seek punitive damages. The district court then concluded that the doctrines of claim and issue preclusion barred Creation’s remaining contract claim.The Seventh Circuit reversed, noting that the case is an “anomaly.” The state court expressly reserved Creation’s right to file the claim in federal court, so the suit is not precluded by its earlier state-court litigation. View "Creation Supply, Inc. v. Selective Insurance Co. of the Southeast" on Justia Law

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Olson and Zdroik sustained injuries while volunteering at municipal fireworks displays in 2018. Fireworks distributed by Spielbauer Fireworks exploded prematurely at both events, severely burning the two. Both towns used teams of volunteers to operate their Fourth of July displays. Olson opened and closed a bin from which other volunteers retrieved fireworks during the Rib Lake show. Zdroik worked at the Land O’Lakes event as a “shooter,” manually lighting the fuses on mortar shells.Spielbauer’s insurer, T.H.E. Insurance, contested coverage under Spielbauer’s general and excess liability policies, which stated: This policy shall NOT provide coverage of any kind ... for any claims arising out of injuries or death to shooters or their assistants hired to perform fireworks displays or any other persons assisting or aiding in the display of fireworks whether or not any of the foregoing are employed by the Named Insured, any shooter or any assistant. The issue was whether the exclusion extends to all volunteers or only to those assisting hired shooters or hired assistants.The Seventh Circuit affirmed, in favor of T.H.E. Insurance. The Shooters Endorsement plainly and unambiguously excludes from coverage hired shooters and their hired assistants and “any other persons” who assist the fireworks display, regardless of whether they assist hired persons. View "T.H.E. Insurance Co. v. Olson" on Justia Law

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Cope, injured on a Kentucky job site, filed a workers’ compensation claim. The subcontractor who hired him for the project, CMC, is based in Southern Indiana, and had an insurance policy with AFICA. Schultheis Insurance Agency procured the policy for CMC, but failed to inform AFICA that CMC did business in Kentucky. AFICA sought a declaration that its policy does not cover Cope’s claim.The district court granted AFICA summary judgment. The Seventh Circuit affirmed. The plain text of the policy is unambiguous: because CMC failed to notify AFICA until after Cope’s accident that it was working in Kentucky, AFICA is not liable for Cope’s workers’ compensation claim. The policy states : “If you have work on the effective date of this policy in any state [other than Indiana], coverage will not be afforded for that state unless we are notified within thirty days.” View "Accident Fund Insurance Co. v. Schultheis Insurance Agency, Inc." on Justia Law

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Greenbank purchased “Thomas” for $500,000, for use as a competitive showhorse. Greenbank obtained insurance from GA that included coverage for Thomas’s “death” or “authorized humane destruction.” In February 2018, Thomas became sick. Over the next few months, Thomas lost 50 pounds and developed cellulitis in all four legs and uveitis in his eye. In April 2018, Greenbank reported Thomas’s pneumonia to GA. Greenbank's veterinarian informed GA that Thomas “probably” needed to be euthanized. GA retained its own veterinarians. Thomas was transported to its facility, where Dr. MacGillivray advised that it would not be unreasonable to make a euthanasia recommendation but she wanted to try treatment. Greenbank objected, arguing that treatment would destroy Thomas’s future athleticism. After his surgery, Thomas made a "remarkable" recovery. Thomas is still doing well.GA denied coverage for certain treatments and rejected Greenbank’s renewal payment of $14,725.000, citing her failure to provide immediate notice of Thomas’s illness in February 2018. Greenbank argued that GA acted in bad faith by unreasonably withholding consent for authorized humane destruction and that GA’s continued care and control over Thomas after the policy terminated constituted conversion and theft.The Seventh Circuit affirmed the dismissal of her claims. Thomas saw three veterinarians in five months; no veterinarian certified that Thomas needed to be euthanized. Nothing in the contract requires GA to protect Thomas’s use as a show horse. Greenbank never made an unqualified demand for Thomas’s return nor did she establish that any demand would have been futile. View "Greenbank v. Great American Assurance Co." on Justia Law